Congenital tuberculosis and management of exposures in a neonatal intensive care unit.

Objectives: We report a case of congenital tuberculosis in a neonatal intensive care unit (NICU) and the management of exposure to other neonates in the hospital. We review the literature regarding congenital tuberculosis and management of exposures in the NICU.

Design: Case report and a survey of exposures with a 3-month follow-up.

Setting: Urban hospital.

Patients: Neonates exposed to a case of congenital tuberculosis.

Interventions: Exposure to tuberculosis was treated with isoniazid. Purified protein derivative tests were placed at baseline and 3 to 4 months after exposure. Chest radiographs were performed if clinically indicated.

Results: Congenital tuberculosis was diagnosed in our patient at 21 days of age during a prolonged hospital course. After initiation of anti-tuberculous medications, the patient gradually recovered from his illness. While he was treated in the NICU, there were 37 potentially exposed infants. Of these, 36 were administered tuberculin skin tests (average age, 1.7 months), all of which were read as 0 mm of induration. Of those 37, 35 began prophylaxis with isoniazid, and 30 were able to complete treatment with a minimum of 3 months of isoniazid therapy. Of those 30, two infants received 6 months of therapy. Additionally, 29 of the 37 infants had chest radiographs, none of which showed suspicious infiltrates or adenopathy. Finally, 30 of the 36 infants had repeat tuberculin skin tests at 3 months, all of which were read as 0 mm of induration (average age, 3.7 months).

Conclusion: Congenital tuberculosis is an uncommon disease t hat requires early diagnosis for successful therapy and vigilant follow-up of potential exposures in the NICU.